PB2054: HIP AND KNEE OSTEOARTHRITIS IN PHILADELPHIA CHROMOSOME-NEGATIVE MYELOPROLIFERATIVE NEOPLASMS
Authors: H. Holik, I. Krečak, I. Samardžić, D. Pilipac, B. Coha, V. Gverić-Krečak, I. Vučinić Ljubičić, M. Lucijanić, I. Rajkovača Latić, L. Vinković, B. Miškić, S. Zupančić Šalek
Journal: HemaSphere (2022)

Background: Hip and knee osteoarthritis (OA) affect approximately 10-15% of persons older than 60 years of age. Considering that Philadelphia chromosome-negative myeloproliferative neoplasms (MPNs) are typically diagnosed in older age and characterized by chronic inflammation, bone marrow remodeling and frequent osteoporosis, we hypothesized that OA may be highly prevalent in MPNs. Aims: To investigate the prevalence of hip and knee OA in MPNs and its associated risk factors. Methods: This is an ongoing prospective two-center study being conducted in Croatia (dr. Josip Bencevic General Hospital, Slavonski Brod and General Hospital of Sibenik-Knin County, Sibenik). Consecutive patients with essential thrombocythemia (ET), polycythemia vera (PV) and myelofibrosis (MF) diagnosed according to 2016 World Health Organization criteria are being prospectively included. All participants with suspected hip and knee OA (asymmetry, pains, swelling, crackling, or reduced flexibility) are being evaluated by an orthopedic surgeon and undergo X-ray imaging of the symptomatic joint(s) with OA being defined as grade ≥1 according to the radiological Kellgreen-Lawrence classification; grades 3-4 represent moderate and severe OA, respectively. Relevant clinical and laboratory data, as well as the MPN Symptom Assessment Form (MPN-SAF), are being recorded at the time of study entry. High-risk ET and PV patients are defined as those having age >60 years and/or history of thrombosis. Cardiovascular risk factors considered were arterial hypertension, diabetes mellitus, hyperlipidemia, and smoking. The study was approved by the Ethical Committees from the participating centers. The chi-square, the Mann-Whitney U, and the t-test were used. MedCalc Statistical Software® was used for all analyses. Results: Fifty MPN patients (ET=18, PV=20, MF 12) were recruited; mean age was 61.5 years (±13.17), 26 (52%) were females, 44 (88%) had symptoms suggestive of OA and 35 (70%) had radiologically confirmed OA, with no statistically significant difference in the prevalences of OA with respect to disease phenotype (61.1% vs. 83.3% vs. 70% for ET, PV and MF, respectively; p=0.428). The prevalence of hip OA was similar among all three disease entities (61.1% vs. 60% vs. 66.7%), whereas knee symptomatic OA was more prevalent in PV (65%) and MF (58.3%) than in ET (22.2%), as shown in Figure 1. Moderate to severe (grade 3-4) hip OA and knee OA were present in 13 (26%) and 9 (18%) MPN patients, respectively, with no statistically significant differences among different disease subtypes (p=0.778 for hip- and p=0.716 for knee OA). Expectedly, the presence of symptomatic hip OA correlated with the presence of knee OA (p=0.002). The presence of symptomatic OA in MPNs was generally associated with high-risk disease (p=0.020), older age (p=0.046), higher body mass index (p=0.015), presence of cardiovascular risk factors (p=0.030), systemic autoimmune disorders (p=0.004), hemoglobin ≤125g/L (p=0.045), hyperuricemia (p=0.076) and high (>8) MPN-SAF (p<0.001). Image:Summary/Conclusion: Out preliminary data suggest that symptomatic OA may have strikingly high prevalence (60-80%) in MPNs, with a substantial proportion of MPN patients having moderate to severe OA (18-26%). Finally, the presence of symptomatic OA in MPNs seems to be predominantly associated with older age, higher body mass index, cardiovascular risk factors, and parameters indicative of a higher degree of inflammation. The accrual is ongoing.